MEDICARE: BELLEAIR HEALTH CARE CENTRE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	OTA10822	FL

General Provider Information

NPI Number	:	1073891248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLEAIR HEALTH CARE CENTRE

Provider Business Mailing Address
First Line	:	2596 COLUMBUS WAY S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-3905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 PONCE DE LEON BLVD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-1041
Country	:	US
Telephone Number	:	727-585-5491
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	STEVE LOMONICO
Credential	:
Telephone Number	:	727-585-5491

Provider Enumeration Date	:	07/22/2011
Last Update Date	:	07/22/2011

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